■在过去的十年中,临床实践指南和教育活动已建议在未降睾丸(UDT)的诊断中使用常规超声(US).我们的目标是确定在此期间,在转诊到我们中心之前,接受美国转诊前的UDT儿童比例是否发生了变化。我们还试图确定转诊专家的类型,UDT诊断,患者与医院的距离影响了美国转诊前的比率.
■对2010年至2019年期间在一家三级儿科泌尿外科转诊中心接受睾丸固定术的儿童的医院图表的部分样本进行了审查。关于手术年龄的数据,隐睾诊断,转诊医生的类型,患者与机构的距离,并提取了作为诊断工作一部分的美国证据。
■检查了500张图表。参考提供商专业影响了美国订购的数量(P=0.01)。关于子集分析,2014年,儿科医生对明显UDT的儿童订购了更少的美国(P=0.03)。2018年,社区泌尿科医生没有订购美国(P=0.02)。这些发现与指南发布有时间关系。每年接受美国治疗的儿童比例一直保持在50%到62%之间,除了2014年,当时只有36%的人拥有美国。与医院的距离和UDT诊断无意义。
■尽管有临床实践指南和明智的竞选建议,大量的UDT儿童仍在接受美国治疗。观察到亚专业指南依从性的瞬时变化。需要考虑提高转诊临床医生的持续指南意识的策略。
OBJECTIVE: Over the past decade, clinical practice
guidelines and educational campaigns have counselled against the use of routine ultrasound (US) in the diagnosis of undescended
testes (UDT). We aimed to establish whether or not there has been change in the proportion of children with UDT undergoing pre-referral US prior to referral to our centre over this period. We also sought to determine whether type of referring specialist, UDT diagnosis, and patient distance from the hospital had impacted the rate of pre-referral US.
METHODS: A select sample of hospital charts of children undergoing orchidopexy at a single tertiary paediatric urological referral centre between 2010 and 2019 were reviewed. Data regarding age at surgery, cryptorchidism diagnosis, type of referring physician, patient distance from institution, and evidence of US as part of diagnostic work-up were extracted.
RESULTS: Five hundred charts were examined. Referring provider specialty impacted the number of US ordered (P=0.01). On subset analysis, paediatricians ordered fewer US for children with palpable UDT in 2014 (P=0.03). In 2018, community urologists ordered no US (P=0.02). These findings had temporal relationships with
guideline release. The proportion of children undergoing US each year remained consistently between 50% and 62%, except in 2014, when only 36% had US. Distance from hospital and UDT diagnosis were of no significance.
CONCLUSIONS: Despite clinical practice
guidelines and Choosing Wisely campaign recommendations, significant numbers of children with UDT still undergo US. Transient changes in sub-specialty
guideline adherence are observed. Strategies to improve sustained guideline awareness in referring clinicians need to be considered.